There Will Be Blood

My doctor appointments are pretty boring. By now, there really isn’t any point to them except standard protocol. I see my doctor, get blood drawn, and discuss any new symptoms or problems that may have arisen. But if I had a substantial complaint to begin with, I would never wait until my appointment to bring it up. If I was getting fevers, having headaches, or bloody noses, I know that’s a bad warning sign and that I better notify someone soon. And so, my doctor appointments are sort of a waste of a copay.

This morning I went to see my nurse practitioner and again everything was pretty standard. I had blood drawn, I got a few prescriptions refilled, and I was once again promised that I would be transplanted soon. For me, everything was typical until I went to make a follow-up appointment. A man and his wife were also there as he sat in a wheelchair waiting to be seen. He was an African-American male in his early forties and he looked absolutely exhausted. The couple did not have an appointment but as he got in the elevator, he began to feel very tired, so much so that he couldn’t even stand. He sat down and when the elevator reached the 14^th floor, someone got him a wheelchair to sit in. Besides his obvious exhaustion, though, he looked pretty healthy. He didn’t have any noticeable jaundice or ascites. Still, while his wife was talking to the secretary he began to pass out. He was awake one minute and then out of nowhere, he closed his eyes and they had to literally shake him to wake up. His health continued to digress from there.

In a matter of minutes, doctors, nurses, and coordinators were all deciding what to do. His wife stood next to him, brushing his face with a cold compress to keep him awake. It was obvious he needed to go to the ER, but they weren’t even sure why. And then, to the horror of everyone around, he started throwing up blood. Bleeding esophageal varices is probably the worse symptom a liver patient can have. There is a thirty percent mortality rate with each horrible episode. When the hepatic portal system becomes blocked due to cirrhosis, the blood flow redirects itself to areas with lower pressure like the esophagus and the belly. These vessels weren’t made for such heavy pressure and risk bleeding.

I’ve had one episode of bleeding esophageal varices and it was the scariest moment of my life. In late March, Aviva was working at the hospital and luckily her sister had decided to stay over. I was restless the entire night, tossing and turning in my bed. Eventually I got up to go to the bathroom and immediately knew I had to throw up. I ran to the toilet and I started throwing up bright red blood. It was a scary site (Aviva later commented that it looked like someone had slaughtered a chicken over our toilet), but I miraculously felt fine. I woke up Tova, my sister-in-law, and told her she needed to drive me to the hospital. In a minute, she was up and we were on our way. When I got to the ER, though, things quickly got worse and while sitting in triage, I began to throw up a thick black blood. I was literally crying from fear as I continued to lose blood. In all my years in the hospital and dealing with Crohn’s and liver disease, I had never given a thought to my mortality until that episode. I lost a third of my blood that evening, but luckily I have been fine since. My varices have subsided and now the risk of bleeding is a lot less.

All the emotions of that night came rushing back to me when I saw this man in the doctor’s office. I’ve always been the patient, dealing with the disease on a personal level. When I became the observer today, I freaked out. Watching someone who was obviously sick, but still looked relatively ok, digress so quickly was really scary. Honestly, I think sometimes it’s harder to be the observer than the patient. Six hours later and the image of that man vomiting is still stuck in my head. I can never imagine the hardships Aviva, our family, and friends, have to deal with when they hear “Yannai’s in the hospital.” Fortunately, Aviva is a nurse and knows how to deal with these sorts of things. But the strength that Tova showed that night in March really amazes me. I ran out of the doctor’s office today shocked and stunned. Being a patient I can handle, it’s the witness that I don’t envy.